Healthcare Provider Details

I. General information

NPI: 1790134195
Provider Name (Legal Business Name): AMBER MCCULLAR GIRARDEAU AUD
Entity Type: Individual
Gender: Female
Sole Proprietor: N

II. Dates (important events)

Enumeration Date: 06/07/2016
Last Update Date: 04/20/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

22530 US HIGHWAY 98 STE 240
FAIRHOPE AL
36532-6398
US

IV. Provider business mailing address

22530 US HIGHWAY 98 STE 240
FAIRHOPE AL
36532-6398
US

V. Phone/Fax

Practice location:
  • Phone: 251-929-9397
  • Fax: 251-929-9396
Mailing address:
  • Phone: 251-929-9397
  • Fax: 251-929-9396

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code231H00000X
TaxonomyAudiologist
License Number1169A
License Number StateAL
# 2
Primary TaxonomyN
Taxonomy Code237600000X
TaxonomyAudiologist-Hearing Aid Fitter
License Number1169A
License Number StateAL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: